Blue Skies of San Marcos

Type of visit: Required - 1 Year

On 04/29/26, Licensing Program Analyst (LPA) Aziz Faizi made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by caregiver Jean Paul Reyes who was informed of the purpose of the visit. The facility is a one-story home with five (5) bedrooms and three (3) bathrooms, including a garage. There are no pools or known firearms on the premises. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. Outdoor shaded seating area is available for the clients in care. The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and more than a seven-day supply of non-perishable foods, which are stored in a safe and healthy manner. LPA observed knives and sharp instruments secured in locked kitchen cabinets. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked and inaccessible to residents. Both the smoke detector and carbon monoxide detector were operational, and the hot water temperature was 109.0°F. Fire extinguisher located in the kitchen meeting department's requirements expiring 04/28/2027. Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate expiring 04/19/2027 . LPAs reviewed files for three (3) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three (3) resident files were reviewed and contained all required documentation. All resident medications were securely locked. LPA reviewed medications for three (3) residents, confirming that all medications were listed on the Medication Administration Record (MAR) and accounted for. LPA reviewed the facility’s emergency and disaster plan, including documentation of the last fire/earthquake drill conducted on 04/06/2026, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed and provided.the state’s words, verbatim · CDSS document, Apr 29, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that six (6) residents live at this facility. There were two (2) staff members. The Lead Caregiver, Jeanpaul Reyes was advised of the annual and came to conduct and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. The Administrator, Hong Hanh Le Dao, Administrator’s certificate expiration date was 04/19/2025. Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 75 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the laundry closet. There is a location for storing laundry soap, cleaning supplies and chemicals in the closet. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There are zero (0) pools at the facility. There is one (1) secured gate that has a self-latching lock located on the northeast side of the house. LPA observed emergency supplies and two (2) first aid kit. The last emergency fire drill was conducted on 12/15/2024. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that staff had infection control training. Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed that they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed seven (7) dual smoke detectors and carbon monoxide detectors throughout the facility. Pursuant to Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to Lead Caregiver, Jeanpaul Reyes.the state’s words, verbatim · CDSS document, Feb 25, 2025

Type of visit: Required - 1 Year

On April 04, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with the Lead Caregiver. The facility file review was conducted in the Regional Office and additional forms were reviewed and requested on site. The facility is licensed for six Adult Residents but is currently serving five. LPA Mixson toured the facility along with the Lead Caregiver, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home located at 1119 Via Vera Cruz San Marcos CA. 92078 Physical Plant: The facility phone number is (760) 736-4099 and it is operable. The LPA observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the Ombudsman postings. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit. Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit, and there were safety lights for night. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharps are locked. Care & Supervision: Facility has sufficient staff, two staff on site at the time of this visit, Licensee was called and interviewed via phone. Records Review: The LPA reviewed resident and staff files, conducted staff interviews, and observed residents engaged in the afternoon meal. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted, and a copy of this report was given to the Lead Caregiver, Jean Paul Reyes.the state’s words, verbatim · CDSS document, Apr 4, 2024

Allegation investigated: Lack of care resulting in serious injury. Staff did not provide incontinence care.

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced complaint investigation visit. LPA Silveira introduced themselves, met with Caregiver Jean Paul Reyes and disclosed the purpose of the visit. The purpose of the visit was to deliver findings for the above-mentioned allegations. The Department’s investigation consisted of interviews with staff, outside sources and a records review. It was alleged that Resident #1 (R1) suffered a fractured vertebrae while in care in October 2021. It was also alleged that R1 was left in soiled clothing for extended periods of time during this same timeframe. A review of a doctor’s report dated 04/26/21 revealed that R1 was diagnosed with Alzheimer’s disease. Based on the doctor’s evaluation, the report indicated that R1 was able to communicate their needs. A review of medical and facility records also demonstrated that R1 was not considered a fall risk. [CONTINUED ON LIC 9099-C] Unsubstantiated [CONTINUED FROM LIC 9099] An interview with Staff #1 (S1) revealed that R1 was found lying on the floor near their bed the evening of 10/20/21. R1 was assisted by S1 back to bed. S1 stated that R1 did not express that they were in pain. S1 stated that R1 did not complain about back pain until the morning of 10/23/21. On 10/23/21 R1 was sent to a hospital Emergency Room due to back pain. Medical Records from that hospital visit on 10/23/21 indicated that R1 was diagnosed with a vertebral body fracture with a subacute injury. A Department interview with R1’s PCP revealed that R1 had a history of back pain due to a medical condition, and had a higher risk of bone fracture due to thinning of the bone. The PCP also stated that a subacute injury indicated that the injury could have happened several days ago or up to several months ago. R1’s PCP stated that it is possible that R1 fractured their vertebrae previously at an unknown date and time and may have aggravated the injury on 10/20/21. A Department interview with an outside source revealed that they spoke to the Emergency Room (ER) doctor who attended R1 on 10/23/21. The ER doctor indicated that R1 had a fractured vertebrae, but it was not determined to be a new injury. The ER doctor also indicated that R1 was diagnosed with a medical condition that causes brittle bones; the fracture could have occurred from R1 just sitting down. The outside source also indicated that they did not believe that R1 had been mistreated or abused by facility staff. The outside source stated that they had visited R1 at the facility on various occasions, and never observed any inappropriate behavior by staff towards R1 or other residents. The outside source also stated that R1 was always found to be clean during facility visits and they do not believe that there were any issues with R1 being left for extended periods of time in soiled clothing. The department attempted to interview other relevant witnesses to no avail. Facility staff denied leaving residents in soiled clothing for extended periods of time. A review of facility and medical records also did not reveal any health issues or care issues related to a lack of incontinence care. Due to a lack of corroborating evidence, the allegations that lack of care resulted in serious injury to a resident and that staff did not provide incontinence care are unsubstantiated. This finding means that although the allegations may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violations occurred. [CONTINUED ON LIC 9099-C] [CONTINUED FROM LIC 9099-C] LPA Silveira conducted an exit interview with Arlan Acosta. At the time of the exit interview Arlan was provided with a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016). The signature on this report acknowledges receipt of the rights.the state’s words, verbatim · CDSS document, Mar 22, 2024 · control 18-AS-20240322110416